Cardiometabolic Disease Risk in Normal Weight Obesity and Exercise Interventions for Proactive Prevention

PURPOSE: Normal weight obesity (NWO) is characterized by a normal body mass index but a high body fat mass percentage and low skeletal muscle mass, thereby increasing the risk of cardiometabolic dysfunction and morbidity. However, the effects of exercise intervention in reducing the risk of cardiometabolic disease in NWO have not been fully elucidated. Therefore, this review aimed to summarize the potential cardiometabolic disease risk and to provide implications of exercise interventions for the proactive prevention of cardiometabolic disease risk in NWO.METHODS: We searched and summarized the literature on the cardiometabolic risk factors in NWO. In addition, we summarized literature investigating the effects of exercise intervention on the cardiometabolic risk factors in NWO. We performed the literature search using PubMed, Web of Science, and Google Scholar databases.RESULTS: NWO was associated with increased visceral fat, ectopic fat, oxidative stress, inflammatory cytokines, insulin resistance, dyslipidemia, and subclinical atherosclerosis compared with normal weight lean. NWO requires exercise interventions that induce alterations in body composition, such as decreased body fat percentage and increased muscle mass. Resistance exercise (RE) and high-intensity interval exercise (HIIE) can improve lipid components and alter body composition in NWO. In addition, low-intensity blood flow restriction resistance exercise (BFR-RE) may enhance muscular strength and anaerobic power in NWO.CONCLUSIONS: The cardiometabolic disease risk is increased in NWO. We suggest that exercise interventions (RE, HIIE, and BFR-RE) may effectively prevent cardiometabolic disease risk and alter body composition in NWO. As this has potential implications for exercise interventions in NWO, further investigations are needed to find the optimal exercise for proactive prevention of cardiometabolic risk in NWO.